Pulmonary and Critical Care Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Curr Opin Crit Care. 2010 Feb;16(1):62-8. doi: 10.1097/MCC.0b013e328334b151.
Studies of the pharmacologic management of acute respiratory distress syndrome (ARDS) have yielded conflicting results. The purpose of this review is to discuss recent pharmacologic trials in ARDS, using the conceptual framework of ARDS as a heterogeneous disease.
Whereas most drug trials in ARDS have been negative, some studies suggest that targeting therapies at subgroups of patients may be successful. Proposed subgroups include early versus late-phase ARDS, direct versus indirect lung injury, and patients with altered coagulation. Corticosteroids have beneficial short-term effects when given at low or moderate doses sooner than 2 weeks but appear to be harmful if initiated later and are of unclear benefit if lung protective ventilation is also used. Surfactant may be helpful in patients with direct lung injury. Anticoagulants and vasodilators may have a greater chance for success in the subset of patients with vascular disease and a high dead-space fraction may identify such a population.
ARDS is a heterogeneous syndrome. Failure to target subgroups more likely to benefit from specific therapies may be one explanation for largely disappointing trial results so far.
急性呼吸窘迫综合征（ARDS）的药物治疗研究结果相互矛盾。本文旨在使用 ARDS 的异质性疾病概念框架讨论 ARDS 的近期药物治疗试验。
虽然 ARDS 的大多数药物试验均为阴性，但一些研究表明，针对患者亚组的靶向治疗可能会取得成功。提出的亚组包括 ARDS 的早期和晚期、直接和间接肺损伤以及凝血功能改变的患者。当在 2 周内尽早以低或中剂量给予皮质类固醇时，其具有短期有益作用，但如果在更晚时开始则可能有害，如果同时使用肺保护性通气，则其益处尚不清楚。表面活性剂可能对直接肺损伤的患者有帮助。抗凝剂和血管扩张剂在血管疾病患者亚组中可能更有成功的机会，而高死腔分数可能可以识别出这样的人群。
ARDS 是一种异质性综合征。迄今为止，大多数试验结果令人失望的一个原因可能是未能针对更有可能从特定治疗中获益的亚组。
